Trichotillomania: A Disorder That Affects Millions
Your fingers find a hair that feels coarse or out of place, and you pull it. Then another. Half an hour later there's a small pile next to you and a spot you'll spend tomorrow covering up. Trichotillomania, or trich, is the name for hair pulling you can't stop on your own.
By Nathan Peterson, LCSW, OCD and BFRB therapistWhat is trichotillomania?
Trichotillomania is repeated pulling of your own hair that leads to hair loss, along with trying to cut back and not being able to. You'll also hear it called trich, TTM, or hair pulling disorder.
It's a body-focused repetitive behavior, or BFRB, the same family as skin picking (dermatillomania) and nail biting. Studies estimate it affects around 1 to 2 percent of people, which is where "millions" comes from. The DSM-5 lists it with OCD and related disorders. Older articles call it an impulse control disorder or a form of self-harm, but that's out of date.
Trich symptoms
- Pulling hair from the scalp, eyebrows, eyelashes, beard, or body
- Noticeable thin spots, bald patches, or missing lashes and brows
- A building tension before pulling, and relief or satisfaction after
- Looking for hairs that feel coarse, kinked, or "wrong"
- Playing with, rolling, or chewing the hair after it's pulled
- Trying to stop over and over without it lasting
- Covering spots with hats, makeup, scarves, or hairstyles
- Avoiding haircuts, swimming, wind, or getting close to people
If this sounds familiar, it could possibly be trichotillomania. A therapist who treats BFRBs can tell you for sure, and you can start with the free hair pulling test. For the full symptom breakdown, see trichotillomania symptoms.
Focused vs. automatic pulling
Pulling tends to show up in two ways, and it's common to do some of both.
Focused pulling
You know you're doing it. A hair feels wrong and you need it gone, or you're stressed and pulling takes the edge off. It can feel like you have to find the "right" one before you can stop.
Automatic pulling
You don't notice until after. You're reading, studying, driving, or lying in bed on your phone, and your hand has been in your hair the whole time.
Knowing which one you do matters, because the fixes are different. Common triggers include boredom, stress, being tired, sitting still, and mirrors or bright bathroom light.
What causes trichotillomania?
There isn't one known cause. It often starts in the preteen or teen years, and it tends to run in families. Stress can make it louder, but pulling also happens when you're calm and bored.
What keeps it going is easier to see. Pulling brings relief or satisfaction for a moment, and your brain remembers that. So the next time you're tense, bored, or feel a hair that's "off," the urge shows up faster.
Trichotillomania treatment
The main treatment for hair pulling, and for BFRBs in general, is a behavioral therapy called habit reversal training, or HRT. It's often combined into a bigger plan called the ComB model.
How habit reversal training works
- Awareness. You learn when, where, and how you pull, including the moment your hand starts moving.
- A competing response. When the urge shows up, you do something with your hands that makes pulling hard, like making a fist or holding an object, until the urge passes.
- Changing the setup. A hat or hood while you study, fidget toys where you scroll, bandages on the fingers you pull with, dimmer light at the mirror.
I know, "hold a fidget toy" sounds too simple for something you've fought for years. The simple part is the point. The work is doing it every time, especially the times you don't want to.
For the full breakdown, see trichotillomania treatment explained.
Why willpower doesn't work
"Stop it" treats pulling like a choice you're making badly. Most of the time the urge shows up before you've decided anything. HRT doesn't wait for you to feel like stopping. It gives your hands a plan for the urge, and lets the urge be there until it fades.
Medication
No medication is approved specifically for trichotillomania. Some doctors prescribe medication to help, so that's a conversation to have with your doctor or psychiatrist.
For the next three days, jot down every time you catch yourself pulling: where you were, what you were doing, and which hand. No fixing yet. (Yes, you'll forget some. Write down that you forgot.)
That list tells you where to start. If you want help turning it into a plan, that's what the course below is for.
Common questions about trichotillomania
Is trichotillomania a form of OCD?
They're related but not the same. The DSM-5 puts trichotillomania in the same group as OCD, obsessive-compulsive and related disorders. OCD rituals are usually about stopping a feared outcome. Hair pulling is usually about an urge, a tension, or a feeling that pulling settles for a moment. Some people have both.
Is hair pulling self-harm?
Usually not. Pulling isn't usually an attempt to hurt yourself, and it often happens without noticing. Older articles call it self-harm, but that's not how it's understood now.
Will my hair grow back?
Often, yes, once the pulling slows down. Hair that's been pulled from the same spot for years can grow back thinner or slower. A dermatologist can tell you more about your own scalp, brows, or lashes.
Can kids have trichotillomania?
Yes. It often starts between the preteen and teen years, and young kids can pull too. For a child, habit reversal training usually involves a parent helping with reminders and setting things up at home.
I eat or chew the hair I pull. Is that part of it?
It can be. Some people with trichotillomania chew or swallow hair. If you swallow hair, tell a doctor, since it can build up in the stomach.
